Statement of Principles concerning malignant melanoma of the skin (Reasonable Hypothesis) (No. 34 of 2024)
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MALIGNANT MELANOMA OF THE SKIN (Reasonable Hypothesis)
(No. 34 of 2024)
The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.
Dated 26 April 2024.
Professor Terence Campbell AM
Chairperson
by and on behalf of
The Repatriation Medical Authority
Contents
1 Name
2 Commencement
3 Authority
4 Repeal
5 Application
6 Definitions
7 Kind of injury, disease or death to which this Statement of Principles relates
8 Basis for determining the factors
9 Factors that must exist
10 Relationship to service
11 Factors referring to an injury or disease covered by another Statement of Principles
Schedule 1 - Dictionary
1 Definitions
1 Name
This is the Statement of Principles concerning malignant melanoma of the skin (Reasonable Hypothesis) (No. 34 of 2024).
2 Commencement
This instrument commences on 28 May 2024.
3 Authority
This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.
4 Repeal
The Statement of Principles concerning malignant melanoma of the skin (reasonable hypothesis) No. 102 of 2015 (Federal Register of Legislation No. F2015L01317) made under subsection 196B(2) of the VEA is repealed.
5 Application
This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies.
6 Definitions
The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.
7 Kind of injury, disease or death to which this Statement of Principles relates
(1) This Statement of Principles is about malignant melanoma of the skin and death from malignant melanoma of the skin.
Meaning of malignant melanoma of the skin
(2) For the purposes of this Statement of Principles, malignant melanoma of the skin:
(a) means a primary malignant neoplasm arising from the melanocytes; and
(b) includes:
(i) melanoma in situ including Hutchinson melanotic freckle/lentigo maligna;
(ii) superficial spreading melanoma;
(iii) lentigo maligna melanoma;
(iv) nodular melanoma;
(v) desmoplastic melanoma;
(vi) amelanotic melanoma; and
(vii) malignant melanoma of the skin of the lip, anogenital region, and acral regions (palms of the hands, soles of the feet, and skin underlying the nails); and
(c) excludes:
(i) malignant melanoma of the eye;
(ii) malignant melanoma of the mucosa; and
(iii) melanocytic naevi.
(3) While malignant melanoma of the skin attracts ICD‑10‑AM codes C43 and D03, in applying this Statement of Principles the meaning of malignant melanoma of the skin is that given in subsection (2).
(4) For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.
Death from malignant melanoma of the skin
(5) For the purposes of this Statement of Principles, malignant melanoma of the skin, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's malignant melanoma of the skin.
Note: terminal event is defined in the Schedule 1 – Dictionary.
8 Basis for determining the factors
The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that malignant melanoma of the skin and death from malignant melanoma of the skin can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces under the VEA, or members under the MRCA.
Note: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.
9 Factors that must exist
At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting malignant melanoma of the skin or death from malignant melanoma of the skin with the circumstances of a person's relevant service:
(1) having at least 5 sunburns at the affected site at least 2 years before clinical onset;
Note: sunburn and clinical onset are defined in the Schedule 1 - Dictionary.
(2) having a burn scar involving the affected site at least 5 years before clinical onset;
(3) having sunlight exposure to unprotected skin for a cumulative period of at least 2,250 latitude equivalent hours before clinical onset;
Note: latitude equivalent hours and unprotected skin are defined in the Schedule 1 - Dictionary.
(4) having ultraviolet radiation exposure from an ultraviolet-emitting tanning device on at least 5 occasions before the clinical onset of malignant melanoma of the skin, where the first exposure occurred more than 2 years before clinical onset;
(5) having PUVA therapy, where:
(a) the first PUVA treatment commenced at least 10 years before clinical onset; and
(b) at least 200 PUVA treatments were administered, before clinical onset;
Note: PUVA therapy is defined in the Schedule 1 - Dictionary.
(6) undergoing solid organ (excluding corneal transplant) or bone marrow transplantation before clinical onset;
(7) being treated with methotrexate or azathioprine within the 5 years before clinical;
(8) being infected with human immunodeficiency virus before clinical onset;
(9) having non-Hodgkin lymphoma at least one year before clinical onset;
(10) having chronic lymphocytic leukaemia/small cell lymphoma at least one year before clinical onset;
Note: Chronic lymphocytic leukaemia/small cell lymphoma is also known as mature B-cell lymphoid leukaemia and small lymphocytic lymphoma.
(11) having Parkinson’s disease for at least 2 years before clinical onset;
(12) for superficial spreading melanoma only, taking oral estradiol menopausal hormone therapy continuously for at least 6 months, more than 2 years before clinical onset;
(13) taking voriconazole continuously for at least 1 year, more than 3 years before clinical onset;
(14) being obese for at least 5 years within the 20 years before clinical onset;
Note: being obese is defined in the Schedule 1 – Dictionary.
(15) consuming at least 30 grams of alcohol per day for at least one year, more than 5 years before clinical onset;
(16) being employed as a firefighter for a cumulative period of at least 10 years, more than 5 years before clinical onset;
(17) inhaling, ingesting or having cutaneous contact with dielectric (insulating) liquids containing polychlorinated biphenyls during the production or repair of capacitors, transformers, or electrical switches, for a cumulative period of at least 2,000 hours, completed at least 20 years before clinical onset;
(18) inability to obtain appropriate clinical management for malignant neoplasm of the skin before clinical worsening.
Note: clinical worsening is defined in the Schedule 1 – Dictionary.
10 Relationship to service
(1) The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.
(2) The factor set out in subsection 9(18) applies only to material contribution to, or aggravation of, malignant melanoma of the skin where it was suffered or contracted before or during (but did not arise out of) the person's relevant service.
11 Factors referring to an injury or disease covered by another Statement of Principles
In this Statement of Principles:
(1) if a factor referred to in section 9 applies in relation to a person; and
(2) that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(2) of the VEA;
then the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.
Schedule 1 - Dictionary
Note: See Section 6
1 Definitions
In this instrument:
being obese means having a Body Mass Index (BMI) of 30 or greater.
Note: BMI is defined in the Schedule 1 - Dictionary.
BMI means W/H2 where:
(a) W is the person's weight in kilograms; and
(b) H is the person's height in metres.
latitude equivalent hours means hours of sunlight exposure multiplied by the appropriate latitude weighting factor as follows:
(a) For tropical latitudes (23.5° South to 23.5° North) multiply by 1.0;
(b) For subtropical latitudes (23.6° - 35°) multiply by 0.75;
(c) For warm temperate latitudes (35.1° - 45°) multiply by 0.5;
(d) For cool temperate latitudes (45.1° - 65°) multiply by 0.25.
Note: sunlight exposure is calculated as the sum of sunlight exposure in each separate latitude, accounting for the different sunlight intensity in each latitude (weighting factor).
Sum of sunlight exposure = (hours spent in tropical latitude x tropical latitude weighting factor) + (hours spent in subtropical latitude x subtropical latitude weighting factor) + (hours spent in warm temperate latitude x warm temperate latitude weighting factor) + (hours spent in cool temperate latitude x cool temperate latitude weighting factor)
malignant melanoma of the skin—see subsection 7(2).
MRCA means the Military Rehabilitation and Compensation Act 2004.
PUVA therapy means a combination treatment consisting of taking oral psoralen (P) (also known as Methoxsalen) and exposing the skin to long-wave ultra-violet light (UVA).
relevant service means:
(a) operational service under the VEA;
(b) peacekeeping service under the VEA;
(c) hazardous service under the VEA;
(d) British nuclear test defence service under the VEA;
(e) warlike service under the MRCA; or
(f) non-warlike service under the MRCA.
Note: MRCA and VEA are defined in the Schedule 1 - Dictionary.
sunburn means painful erythema of the skin of at least 48 hours duration, resulting from exposure to solar ultraviolet radiation.
terminal event means the proximate or ultimate cause of death and includes the following:
(a) pneumonia;
(b) respiratory failure;
(c) cardiac arrest;
(d) circulatory failure; or
(e) cessation of brain function.
unprotected skin means skin that is directly exposed to the sun and is not protected by sunscreen, clothing or other physical barrier.
VEA means the Veterans' Entitlements Act 1986.
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